OMB APPROVAL |
OMB Number: 3235-0145 |
Expires: December 31, 2005 |
Estimated average burden hours per response...15 |
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
SCHEDULE 13D
Under the Securities Exchange Act of 1934
(Amendment No. )*
If the filing person has previously filed a statement on Schedule 13G to report the acquisition that is the subject of this Schedule 13D, and is filing this schedule because of §§240.13d-1(e), 240.13d-1(f) or 240.13d-1(g), check the following box. o
Note: Schedules filed in paper format shall include a signed original and five copies of the schedule, including all exhibits. See §240.13d-7 for other parties to whom copies are to be sent.
* The remainder of this cover page shall be filled out for a reporting persons initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page.
The information required on the remainder of this cover page shall not be deemed to be filed for the purpose of Section 18 of the Securities Exchange Act of 1934 (Act) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
1
CUSIP No. 00178W105 | ||||||
1. | Name of Reporting Person: Fredric Mack |
I.R.S. Identification Nos. of above persons (entities only): |
||||
2. | Check the Appropriate Box if a Member of a Group (See Instructions): | |||||
(a) | o | |||||
(b) | o | |||||
3. | SEC Use Only: | |||||
4. | Source of Funds (See Instructions): PF |
|||||
5. | Check if Disclosure of Legal Proceedings Is Required Pursuant to Items 2(d) or 2(e): o | |||||
6. | Citizenship or Place of Organization: USA |
|||||
Number of Shares Beneficially Owned by Each Reporting Person With | ||||||
7. | Sole Voting Power: 435,000sh | |||||
8. | Shared Voting Power: 0 | |||||
9. | Sole Dispositive Power: | |||||
10. | Shared Dispositive Power: 0 | |||||
11. | Aggregate Amount Beneficially Owned by Each Reporting Person: 435,000 |
|||||
12. | Check if the Aggregate Amount in Row (11) Excludes Certain Shares (See
Instructions): o |
|||||
13. | Percent of Class
Represented by Amount in Row (11): 6.42% | |||||
14. | Type of Reporting Person (See Instructions): IN | |||||
2
Introductory Note
3
Item 1. Security and Issuer. AMS Health Sciences, Inc. - Common Stock
Item 2. Identity and Background. See Below
Item 3. Source and Amount of Funds or Other Consideration. Personal Funds - $1,691,151.00
Item 4. Purpose of Transaction Investment
Item (2)
(a) Fredric Mack
(b) 2115 Linwood Ave., Ft. Lee, NJ 07024
(c) Real Estate Development, 2115 Linwood Ave., Ft. Lee, NJ 07024
(d) No
(e) No
(f) US Citizen
4
Item 5. Interest in Securities of the Issuer. 6.42%
Item 6. Contracts, Arrangements, Understandings or Relationships with Respect to Securities of the Issuer. None
Item 7. Material to be Filed as Exhibits
None.
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
Dated: February 17, 2004
By: | /s/ Fredric Mack | |||
Name: | Fredric Mack | |||
5